Rapid vascular access is critical in resuscitation of patients during clinical emergency. Even though peripheral intravenous (IV) access is a preferred, many a times it is difficult to access these veins. This usually happens in patients of cardiac arrest, trauma, profound blood loss, severe dehydration and burn injury especially in the pre-hospital setting. Failure rates of peripheral IV access in these emergency conditions have been reported in 10-40% cases. Precious time is lost to access these collapsed peripheral veins in this golden period of patient care. This delay leads to substantial morbidity and mortality.
Intraosseous (IO) access is an alternative to difficult IV access under these clinical situations. IO access allows infusion of fluids directly into the intra-medullary space of the long bones. This space, where the IO needle gets inserted is highly vascular and provides a direct conduit to the systemic circulation. These intra-medullary venous channels are supported by bony matrix, keeping it open even in the presence of shock.
Intra-osseous infusion has long been the standard of care in pediatric emergencies when rapid IV access is not possible. The U.S. military used the hand driven IO needles for infusions extensively and successfully during World War II. However, such IO needles were cumbersome, difficult to use, and often had to be manually driven into a bone.
Drugs administered intra-osseously enter a patient's blood circulation system as rapidly as they do when given intravenously. In essence, bone marrow may function as a large non-collapsible vein.
Traditionally, the bone marrow aspiration process may be conceded out by inserting the needle through the skin into the bone and a syringe is used to draw out the bone marrow. Conventional devices for achieving bone marrow aspiration include a needle with a trocar that is put in the bone either manually or through springs. The impact of the needle may result in bone fracture and pain to the patient. Further, in conventional devices, while accessing the bone marrow due to lack of controlled movement of the needle involves a risk of either needle overshoot or undershoot through cortical layers of the bone. This is mainly because of uncertainty or blindness associated with the procedure, as the operator is not aware of the position of the needle.
Further, in the conventional devices used for bone marrow aspiration, the needle bends or breaks due to the force applied particularly in adult patients who have hard, calcified cortical layer of bone. Also the operators tend to use the same needle for multiple aspirations, thereby leading to infections.
In resource constrained settings, it is important to have a device which is ready to use with no preparation required on-site. Also, such device once used, should not be re-usable to prevent infections. The available devices are reusable and need sterilization prior to use which is a great drawback in resource-constrained setting.
The process of sterilization prior to use is a time consuming process and many times even after the sterilization there is a risk of contamination and possibility of spreading infection by the re-use of the device.
With reference to the above mentioned drawbacks there is need for a non-reusable intra-osseous access device and bone marrow aspiration device, which can get the access to the bone through hard cortical region, and which can be easily rendered non-reusable after establishing the access into the marrow region.